Solving the Enigma of Outsourcing Medical Coding Services

July 20,2016 / By Josh Knoll

Josh Knoll

The title of this post may come across as a riddle to many. After all, when it comes to outsourcing medical coding services to a third-party service provider, there is little mystery in the process. However, two of the biggest challenges associated with it are, understanding if outsourcing is really required and finding a competent coding agency to outsource to.

The first is a no-brainer, and can hardly be called an enigma. Most organizations can quickly discern the tell-tale signs that tell them that their billing and coding processes are leaving a lot to be desired. For example, if there is a steady rise in the number of denied claims, rapidly accumulating accounts receivable or a sharp drop in the revenue, it is time for a close scrutiny of existing operations.

Medical coding, especially with the advent of the ICD-10 standard, has only got more complicated. Most insurance companies maintain a rather unforgiving stand when it comes to errors in coding. A missed modifier or a wrong code can lead to an entire claim getting rejected. While 100% accuracy is an improbability, any significant drop needs to be looked into and rectified as soon as possible.

Outsourcing emerges as one of the most practical and effective ways to curb this menace. Medical coding – be it CPT, HCPCS or ICD-10 CM – requires dedicated attention and expert handling. And this is something that professional coding agencies are known to provide. Is it any wonder then that healthcare organizations in need of better coding solutions are turning to such agencies in large numbers the world over?

The challenge that remains, therefore, is choosing the best man for the job. With thousands of medical billing & coding companies doing business today, both onshore and off-shore, picking the best one can appear to be a Herculean effort. There is no easy way to make a checklist of features and capabilities that you should consult in order to make the job easy.

However, some of the things that you may want to bear in mind while deciding include:

~ Experience in medical coding: Think in terms of years in business and number of clients served.

Certification: Look for organizations with certified coders. Also ask about how they are trained and the measures they adopt to keep abreast of the latest changes.

HIPAA compliance: If you truly care about maintaining strict confidentiality about sensitive patient data (and there is no reason why you shouldn’t), insist on an organization with a well-founded compliance system in place. Adhering to HIPAA-HITECH guidelines is an absolute must in this regard.

Quick TAT: Turnaround time is a good measure of not just promptness, but also of professionalism. As a rule of thumb, shun companies with TAT greater than 48 hours.

The enigma of medical coding outsourcing is not a baffling one. It can be solved with ease if one adopts a logical approach to the matter. Keep a watch on the bottom line of your business, and you will soon be able to tell if your decision to outsource has been a good one.


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